Application Form

Instructions:
Please fill out all applicable information in the spaces below. Return the form to Dr. Terrell in Butcher Education Center 114. Dr. Terrell will verify your eligibility. You should include the $45.00 (any person not qualified to join will have their fee returned). Please make you check payable to Alpha Kappa Delta or AKD. If you have any questions or problems, please visit our website at

http://www.emporia.edu/socanth/akd/officers.htm for names of officers. Thank you for your interest in AKD!!

Today's Date _______________________________


Name (as you want it to appear on your membership certificate):

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First, Middle, Last

Mailing Address:

Street:_____________________________________________________

City: _________________________ State : __________ Zip: ________

Local Telephone No: _______________   E-mail address: _____________________

Major(s): _________________________________ Minor: ______________________

GPA (example 3.2)   Overall _______   Sociology ________

Academic Year: (circle)   JR   SR

Anticipated semester and year of graduation: ______________________________

 Please list all Sociology courses completed:

____________________________________________________________________

____________________________________________________________________

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